Long-term Follow-up Of Patients Research Articles

Long-term Follow-up of Patients Undergoing Nephrectomy for Urolithiasis.

This prospective study aimed to identify risk factors associated with progression to stage 3 chronic kidney disease (CKD) and the occurrence of kidney stone formation or growth following nephrectomy for urolithiasis. From January 2006 to May 2013, patients undergoing nephrectomy for urolithiasis were enrolled. Renal function was assessed using estimated glomerular filtration rate (eGFR) via the Chronic Kidney Disease Epidemiology Collaboration equation, while kidney stone events were detected using computed tomography. Among 107 patients followed for an average of 83.5 months, type 2 diabetes mellitus (T2DM) significantly increased the risk of progression to stage 3 CKD by 34.79-fold (p=0.004). Age was associated with a 15% increase in the odds of developing stage 3 CKD per year (p=0.01), while higher preoperative eGFR was protective (OR=0.84, p<0.01). DMSA-99mTc values below 15% were less likely to lead to renal function deterioration. New kidney stone formation occurred in 15.9% of patients and stone growth observed in 12.1%. Contralateral kidney stones (p<0.01) and hypercalciuria (p=0.03) were identified as risk factors for kidney stone events. T2DM and age were predictors of CKD progression, while higher preoperative eGFR was protective. Hypercalciuria and contralateral kidney stones increased the risk of kidney stone formation and/or growth post-nephrectomy for urolithiasis.

Long-term survival from a randomized controlled trial of lobectomy by video-assisted thoracoscopic surgery versus thoracotomy for early-stage lung cancer.

We previously did a randomized clinical trial of lobectomy by VATS or thoracotomy for early-stage lung cancer and found that patients who underwent VATS had less postoperative pain and better quality of life compared with thoracotomy. VATS has since been regarded the preferred surgical method for early-stage lung cancer. It is assumed that long-term survival is not influenced by surgical approach, but this assumption primarily rests on non-randomized comparative studies. We decided to do a long-term follow-up of patients who entered our previous randomized trial. Between 2008 and 2014 we randomly assigned 206 patients to VATS (n = 103) or anterolateral thoracotomy (n = 103) for proven or suspected early-stage NSCLC. Records from patients with NSCLC on final pathology were identified in the national electronic patient-record system and the Danish Lung Cancer Registry. Overall, disease-free, and cancer-specific survival were estimated using the Kaplan-Meier method and log-rank test was used to compare the two interventions. A total of 196 patients had NSCLC on final histopathology. Four patients were lost to follow-up and the remaining 192 were included in this follow-up study with 128 events used for overall survival analysis, 100 events for disease-free survival analysis and 79 events for cancer-specific survival analysis. VATS was used in 99 patients versus 93 by thoracotomy. Median age at time of surgery was 66 years (range 41-85 years). After a median follow-up time of 12.8 years (range 9.9-15.8 years), 33% of patients were alive. Overall, disease-free, and cancer-specific survival were not significantly different between VATS and thoracotomy: Overall survival (p = 0.29), disease-free survival (p = 0.17) and cancer-specific survival (p = 0.31). We did not find any statistically significant differences in overall, disease-free, or cancer-specific survival between VATS and thoracotomy. However, larger trials with better power for survival analysis are needed to fully explore if there are differences. Alternatively, differences in survival between thoracotomy and VATS for early-stage NSCLC could be investigated by pooling survival data from two similar randomized trials that have since been published.

P0920 Long term follow-up of patients with ulcerative colitis after suspension of infliximab for stable deep remission

Abstract Background Infliximab (IFX) is the first anti-TNF biologic drug approved for treating moderate to severe ulcerative colitis (UC). While IFX is effective in inducing mucosal healing and enhancing quality of life, concerns persist about the long-term safety and cost-effectiveness of extended immunosuppression. Current guidelines lack clarity on when to discontinue treatment after achieving stable deep remission. Moreover, existing literature is limited to studies characterised by small sample sizes and heterogenous criteria for defining remission. We aimed to evaluate the outcomes in UC patients who discontinued IFX after achieving stable deep remission, to identify predictors of relapse post-discontinuation, and to examine the clinical course in those who experienced a relapse. Methods In this single-center, retrospective, observational study, we analyzed UC patients at our tertiary IBD Referral Center who discontinued IFX due to sustained deep remission, defined as the combination of partial Mayo subscore ≤ 1 and endoscopic Mayo score = 0, and who had at least 1 year of follow-up post treatment withdrawal. We assessed the relapse rates at intervals of 6 months, 1 year, 2 years, and beyond 2 years post-IFX discontinuation. For patients who relapsed, we recorded the therapeutic strategy and its effectiveness, including the necessity for colectomy. We performed univariate and multivariate analyses to identify relapse predictors post-treatment suspension. Results From 2006 to 2022, 790 UC patients received IFX treatment at our center; 113 patients suspended IFX due to stable deep remission with at least 1 year of follow-up and were included in this study. Of these, 41.6% maintained remission over a median of 5.17 years. Flare rates were 14.2%, 23.9%, and 35.5% within 6, 12, and 24 months, respectively, with 58.4% experiencing a flare overall. Multivariate analysis showed that longer treatment duration reduced relapse risk (p=0.001), while steroid use during IFX treatment and early IFX initiation post-diagnosis increased relapse risk (p=0.004 and p=0.043, respectively). Most patients who relapsed were successfully managed medically either with a course of steroids, restarting IFX, or initiating a different type of biologic/small molecule, whereas the rate of colectomy was 7.1%. Conclusion This study is one of the largest to date with the longest follow-up that evaluates outcomes post-IFX discontinuation in UC patients in deep remission. Our findings suggest that withdrawal of IFX treatment can be considered in carefully selected cases. In patients who relapse after IFX suspension, medical treatment is often effective, and the rate of colectomy is low. Further studies are warranted to better identify ideal candidates for treatment withdrawal.

Long-term side effects of neurotoxicity of antitumor therapy in children who survived lymphoid tumors

Relevance. Improving the diagnosis and treatment of children with lymphoid tumors (LT) contributes to an increase in the number of cured patients. Antitumor therapy has a side effect on the nervous system, and can lead to neurotoxic consequences. Due to the increased life expectancy of children cured of LT, the assessment of the long-term neurotoxic effects of antitumor therapy is relevant.Objective: based on the literature data, to study the long-term neurotoxic side effects of antitumor therapy in children cured of LT.Material and methods. When writing a literature review, data were analyzed in specialized medical databases Pubmed, Scopus, Web of Science on research in children cured of lymphoid tumors from 1993 to 2023.Results. In cured children from lymphoid tumors, the long-term neurotoxic effects of therapy containing methotrexate in high doses are manifested by neurocognitive decline and structural changes in the brain. Late peripheral neuropathy caused by vincristine affects the quality of life of patients in physical and social aspects. However, the prognostic parameters of long-term neurotoxic effects in children cured of LT have not been determined. The issues of monitoring patients in the long term have not been sufficiently studied. This will contribute to the rehabilitation and long-term follow-up of patients with oncohematological diseases, and improve their quality of life.

Sex Differences in Sudden Cardiac Death During Long-Term Follow-up in Patients With Chronic Heart Failure - A Report From the CHART-2 Study.

Although sudden cardiac death (SCD) generally occurs more frequently in men than in women, there are limited data on sex differences in SCD in patients with chronic heart failure (HF) across a range of left ventricular ejection fraction (LVEF). We examined sex differences in SCD incidence, timing, and risk factors in 4,683 patients with chronic HF (3,186 men, 1,497 women) from a multicenter prospective observational cohort study (CHART-2). Over a median follow-up of 8.8 years after study enrollment, there were 215 SCDs (160 in men, 55 in women). The SCD incidence rates in men and women were 6.1 and 4.6 per 1,000 person-years, respectively (P=0.088). Among women, more than half the SCDs occurred in the first 5 years of follow-up. Beyond 5 years, the SCD incidence rate was significantly lower in women than in men (3.6 vs. 5.9 per 1,000 person-years, respectively; P=0.044). After adjusting for confounders, age, increased B-type natriuretic peptide, and LVEF <50% were common prognostic factors. After 5 years of follow-up, left ventricular (LV) enlargement was a risk factor for SCD in both sexes. These results indicate that there are sex differences in SCD, especially beyond 5 years of follow-up, with a lower prevalence in women. LV enlargement is a common long-term prognostic factor in both sexes, suggesting the importance of preventing LV remodeling in HF management.

Impact of hysterectomy on opioid use in patients with adenomyosis: A nationwide register study.

Dysmenorrhea and heavy menstrual bleeding are the most common symptoms in adenomyosis, in addition to infertility and chronic pelvic pain. Hysterectomy is a common treatment for adenomyosis symptoms with curative effect on heavy menstrual bleeding but with less studied effects on pain reduction. This is a nationwide retrospective register-based cohort study including all hysterectomized patients with pathology-verified adenomyosis between 1 January 2012 and 31 December 2015 with a long-term follow-up three years pre- and three years postoperatively. Two national registers were linked in order to describe the primary outcome of proportion with use of opioids among hysterectomized patients with and without adenomyosis pre- and postoperatively. Logistic and multinomial regression models were used. A total of 2,228 (15%) patients had pathology-verified adenomyosis. Overall opioid use was 18.6% and 21.1% three years before and three years after surgery, respectively. Results showed a significantly increased risk of opioid use three years after hysterectomy in patients with preoperative use of opioids and antidepressants (adjusted Odds Ratio (aOR) 5.7, 95% Confidence Interval (CI) 4.5-7.2 and aOR 1.4, 95% CI 1.1-1.8). The risk of needing long-term opioids was higher among patients with smaller uteri (<300g, aOR 2.8, 95% CI 1.7-4.7) compared to women with uterine sizes ≥600g. Hysterectomy does not reduce opioid use among adenomyosis patients in long-term follow-up, although the subjective reduction of pain was not investigated in this study. Women with preoperative use of opioids/antidepressants and uterine size <300g are at increased risk for chronic opioid use.

Can Topical Glyceryl Trinitrate be Effective in the Treatment of Levator Ani Syndrome?

Levator ani syndrome (LAS) is a pathology that is both difficult to diagnose and treat. The effectiveness of current treatments, which are mostly administered with special devices in advanced healthcare centers, is controversial. The aim of the study is to investigate the effects of glyceryl trinitrate, which is easily accessible and can be applied by the patient, in the treatment of LAS. The study cohort comprised 16 patients with LAS diagnosed and received 0.4% topical glyceryl trinitrate treatment rectally. At the first month of treatment, it was observed that the symptoms and puborectal muscle tension of 15 (93.7%) patients had completely resolved. One patient with persisted symptoms was referred to an advanced center. Symptomatic relief continued in 14 (87.5%) of the 15 patients at the third month of treatment and there were no pathological findings in the rectal examination. The visual analog scale score significantly decreased after the treatment (P < .001). It is thought that topical glyceryl trinitrate treatment may be at least as effective as current treatment methods. Although the number of patients is small, our study is inspiring as it is the first time this molecule has been tried in the treatment of LAS in the literature. More comprehensive randomized controlled studies with long-term follow-up of patients are needed.

Commentary: Symptomatic Progression, Recurrence, and Long-Term Follow-Up of Patients With Intracranial Epidermoid Cysts.

Commentary: Symptomatic Progression, Recurrence, and Long-Term Follow-Up of Patients With Intracranial Epidermoid Cysts.

Chronic kidney disease as a predictor of long-term adverse cardiovascular outcomes in patients with aortoiliac disease: a prospective cohort study.

Aortoiliac disease poses a significant cardiovascular (CV) risk, especially in individuals with chronic kidney disease. This study aimed to assess the predictive role of chronic kidney disease in long-term major adverse CV events in patients submitted to aortoiliac revascularization due to severe aortoiliac atherosclerotic disease. From 2013 to 2023, patients who underwent aortoiliac revascularization for TASC II type D lesions, including those with chronic kidney disease, were selected from a prospective cohort study. Demographic, clinical, and postoperative data were collected. Prognostic factors were evaluated for their independent impact on outcomes using survival analysis with a multivariate Cox regression model. The study included 135 patients, 93.3% male, with a mean age of 62.39±9.20 years. Chronic kidney disease was associated with higher prevalence of short-term myocardial injury after noncardiac surgery (54.5%, P=0.014) and was a long-term predictor of acute heart failure (Hazard Ratio=4.884; 95% confidence interval 2.377-22.802; P=0.007), major adverse CV events (HR 2.992; 95% CI 1.498-5.975, P=0.002) and all-cause mortality (HR 3.296; 95% CI 1.626-6.682, P<0.001). The multivariable analysis revealed significant associations between major adverse CV events and the following predictors: chronic kidney disease (adjusted HR=2.416, 95% CI 1.171-4.984, P=0.017) and congestive heart failure (adjusted HR=2.633, 95% CI 1.233-5.623, P=0.012). Chronic kidney disease is a recognized CV risk factor and an independent predictor of long-term acute heart failure, major adverse CV events, and all-cause mortality. These findings underscore the importance of early identification of CV complications and stricter long-term follow-up for chronic kidney disease patients undergoing aortoiliac revascularization.

Costal fracture assessment for relief and enhancement of quality of life-CARE study.

Rib fractures account for 10-15% of trauma-related hospital admissions. Few data are available regarding long-term follow-up of patients undergoing non-operative management. Our aim is to evaluate quality of life at 1, 2, 4, 12 and 24weeks from the trauma. Pain management, respiratory infection rate and length of hospitalization (LOS) will be recorded. Patients with rib fractures older than 18years of age will be prospectively included. cognitive impairment, chronic pain due to pathologic fractures, active cancer. Patients will be asked to complete a specific survey at 1, 2, 4, 12 and 24weeks from the trauma to assess their quality of life. Pain management, respiratory infection rate and LOS will be recorded. gov ID NCT06405841. The study will provide a detailed quality of life assessment for patients with rib fractures treated conservatively. It will identify the most effective types of analgesic therapies in controlling rib fracture-related pain, respiratory infections rate, and LOS. The results could have broad practical applications, providing guidance on best practices for rib fracture treatment. This could lead to greater efficacy in management protocols, reducing or increasing the need for surgical interventions. The study could have a significant impact on the health-care system by providing evidence to optimize healthcare resources through more targeted management. If the results demonstrate that conservative treatment is ineffective for certain types of fractures, these patients could be selected for surgical treatment, resulting in savings for the healthcare system and improvement in patient quality of life.

Long-Term Effects of COVID-19 on Optic Disc and Retinal Microvasculature Assessed by Optical Coherence Tomography Angiography.

Objectives: To evaluate the long-term effects of coronavirus disease (COVID-19) on optic disc and macular microvasculature. Methods: 40 post-COVID-19 and 40 healthy subjects were included. Optical coherence tomography angiography (OCTA) was performed for all subjects at the first visit and repeated in the fourth and twelfth months. Radial peripapillary capillary (RPC) vessel density (VD), retinal nerve fiber layer (RNFL) thickness, foveal avascular zone (FAZ) area, FAZ perimeter, VDs of the fovea, parafovea, and perifovea at superficial capillary plexus (SCP) and deep capillary plexus (DCP), and central macular thickness (CMT) were evaluated. The OCTA measurements of the COVID-19 group were compared with the control group. Results: The COVID-19 group showed lower VD values than the control group in the nasal parafoveal quadrant of the SCP at all visits (p = 0.009, p = 0.47, p = 0.042) and in the superior perifoveal quadrant of the DCP in the twelfth-month visit (p = 0.014). At all visits, FAZ area and FAZ perimeter were higher (p = 0.02, p = 0.02, p = 0.002; p = 0.002, p = 0.003, p = 0.005), foveal VD values of both SCP and DCP were lower (p < 0.001, p < 0.001, p < 0.001; p = 0.005, p = 0.001, p = 0.001), and CMT was lower (p < 0.001, p = 0.001, p = 0.001) in the COVID-19 group. The COVID-19 group had higher temporal quadrant RPC at all visits (p = 0.003, p = 0.003, p < 0.001) and higher average, superior and inferior RNFL at first and fourth-month visits (p = 0.014, p = 0.020; p = 0.001, p = 0.003; p = 0.021, p = 0.024). Conclusions: There are long-term changes that mainly point to the ischemia in the COVID-19 patients. We emphasize the need for long-term ophthalmologic and systemic follow-up of COVID-19 patients regarding potential complications.

Multiparametric cardiovascular magnetic resonance in patients with myocarditis with consecutive follow-up and a comparison between non-COVID-19 and COVID-19-associated myocarditis.

The pattern of myocardial injury and dysfunction development during follow-up is unclear in patients with myocarditis. This study aims to explore the developmental pattern of myocardial injury and cardiac dysfunction during the follow-up of myocarditis by cardiac magnetic resonance (CMR) and differences in short-term follow-up CMR performance between patients with coronavirus disease 2019 (COVID-19)-associated myocarditis (CAM) and non-COVID-19-associated myocarditis (NCAM). Data of patients with clinically diagnosed myocarditis who underwent follow-up CMR were retrospectively collected. Patients were divided into the NCAM follow-up and CAM follow-up groups. A portion of patients with normal CMR and volunteers was categorized as control. Qualitative and quantitative assessments of CMR images were used to analyze cardiac structure, function and myocardial damage; compare the differences between the groups; and reveal the developmental pattern in the consecutive follow-up for patients with myocarditis. This study included 75 patients with NCAM, 25 patients with CAM and 75 cases as control group. Compared with the control group, there was an increase in left ventricular volume, right ventricular volume, extracellular volume in the NCAM follow-up (the last time) group, left ventricular volume, right ventricular ejection fraction, global radial strain (GRS), global circumferential strain, global longitudinal strain (GLS), post-contrast T1 value were decreased. The area under the curve of the GLS was the best (0.836) in discriminating between the two groups, with 78.7% sensitivity and 84.0% specificity. The discriminatory efficacy of the combined right ventricular ejection fraction, GRS, and GLS multiparameter showed the best area under the curve at 0.847, with 80.0% sensitivity and 85.3% specificity. Between the CMR parameter of short- (3 months), medium-, and long-term follow-up (>6 months) for patients with NCAM, a decrease in native T1 (1,256.50±18.63 vs. 1,248.30±17.87 ms, P=0.007) and T2 (49.00±1.34 vs. 47.50±0.97 ms, P=0.015) values was noted in the short-term follow-up group. The short-term follow-up group showed increased ventricular volume, decreased ejection fraction, and impaired myocardial strain in CAM and NCAM compared with the control group. The CAM short-term follow-up group showed an increased T2 value (52.56±3.64 vs. 49.08±3.84 ms, P=0.008) compared with the NCAM short-term follow-up group, and the T2 value was identified with an area under the curve of 0.772, 76% sensitivity, and 83% specificity for the discrimination. This study revealed that myocarditis led to myocardial damage, cardiac remodeling, and dysfunction during follow-up. An improvement in myocardial edema in the medium- and long-term follow-up groups was observed. In the short-term follow-up, CAM showed more severe myocardial edema. These findings may contribute to the clinical assessment and management of post-myocarditis status.

Long-Term Follow-Up in Patients with Modified Fontan: Assessing Outcomes, Complications, and Management Strategies for Single-Ventricle Survivors

Long-Term Follow-Up in Patients with Modified Fontan: Assessing Outcomes, Complications, and Management Strategies for Single-Ventricle Survivors

Symptomatic Progression, Recurrence, and Long-Term Follow-Up of Patients With Intracranial Epidermoid Cysts.

Intracranial epidermoid cysts are rare, slow-growing but highly recurrent tumors with incompletely understood symptoms, progression, complications, and outcomes. The aim of the study was to characterize the symptomatology, surgical management, and long-term outcomes of these tumors. This single-center retrospective analysis identified patients with pathologically confirmed intracranial epidermoid cysts from 1989 to 2023. Demographic and clinical variables were collected at diagnosis, before and after each resection, and at the latest follow-up. Differences across time points were evaluated using analysis of variance with post hoc Tukey's honestly significant difference tests and Pearson χ2 test with posthoc Bonferroni-corrected z-tests for independent proportions (significance: P ≤ .05). Kaplan-Meier, Cox regression, and multivariate logistic regression analyses were used to investigate predictors for recurrence-free survival and 30-day readmission following first surgery, respectively. Of 146 patients in the final cohort, the average age at diagnosis was 40.3 years, and 52.1% of patients were female. The mean maximum tumor dimension at presentation was 4.3 cm. Most presenting symptoms were significantly reduced at the latest follow-up, including headaches (presentation: 40.4%/latest follow-up: 8.8%, P < .001), vertigo/nausea/vomiting (33.1%/3.7%, P < .001), ataxia/incoordination (22.8%/4.4%, P < .001), and seizures (11.8%/2.9%, P < .005). Similarly, significant improvements were observed in cranial nerve (CN) II deficits (11.0%/3.7%, P = .020) and CN V (11.8%/3.7%, P = .012) and CN VIII excitatory symptoms (11.8%/2.9%, P = .005). Following the first resection, 12.5% of patients were readmitted within 30 days; lumbar drain placement was associated with higher odds of readmission (adjusted odds ratio [95% CI] = 8.26 [1.29-88.19]). Evidence of tumor remnant on the immediate postoperative MRI was associated with a shorter time to recurrence following the first surgery (P = .023). The clinical progression of intracranial epidermoid cysts is marked by a spectrum of troublesome presenting symptoms and a notable tendency for recurrence, particularly following subtotal resection. Nevertheless, symptomatic improvement is the rule even if reoperations are needed, and mortality is exceedingly rare.

Long-term follow-up of patients with a first clinical demyelinating event (clinically isolated syndrome) who received cladribine tablets in CLASSIC-MS: Findings for the ORACLE-MS cohort

Background: CLASSIC-MS explored long-term outcomes of patients treated with cladribine tablets. Objective: Assess long-term efficacy in patients previously enrolled in ORACLE-MS, a Phase III parent trial. Methods: ORACLE-MS included patients with a first clinical demyelinating event (FCDE or clinically isolated syndrome) who received ⩾1 course of cladribine tablets or placebo. With a median follow-up time of 9.5 years, CLASSIC-MS assessed conversion rates to clinically definite multiple sclerosis (CDMS), time-to-conversion, relapse rates, long-term mobility/disability status and subsequent disease-modifying therapy (DMT) use. Results: Of 227 patients from the ORACLE-MS cohort of 616, 68.7% were exposed to cladribine tablets and 31.3% were never exposed. Of the exposed patients at risk, 51.5% converted to CDMS with a median conversion time of 8.4 (95% confidence interval (CI): 5.4–not estimable) years, versus 80.6%, median time 0.8 (95% CI: 0.3–2.4) years, for never exposed. Exposed patients were less likely to be using a wheelchair or ambulatory device or receive subsequent DMTs, and 53.2% were relapse-free versus 28.2% never exposed. Conclusions: Proportionally, more FCDE patients exposed to cladribine tablets experienced delayed conversion to CDMS and fewer relapses and were less likely to use a wheelchair or ambulatory device than never-exposed patients, at 9.5 years (median).

Therapeutic nipple-sparing mastectomy: a scoping review of oncologic safety and predictive factors for in-breast recurrence.

Breast cancer is a common disease, with mastectomy remaining necessary in a proportion of patients. Nipple-sparing mastectomy with reconstruction improves cosmesis compared with traditional nipple-sacrificing techniques. However, concerns regarding increased rates of local recurrence in the retained skinfold and nipple-areolar complex exist. The aim of this scoping review is to assess the incidence of in-breast recurrence after therapeutic nipple-sparing mastectomy and analyze predictors of recurrence. A systematic search was conducted using Ovid MEDLINE(R) ALL and Cochrane Library databases, with keywords related to 'nipple-sparing mastectomy' and 'local recurrence'. Studies that reported rates of in-breast recurrence for patients who underwent therapeutic nipple-sparing mastectomy with immediate breast reconstruction were included. 1465 search results were identified, with 17 studies meeting eligibility criteria. The included studies encompassed 7280 patients, with median follow-up time ranging from 28 to 156 months. Nipple-areolar complex, local, regional and locoregional recurrence ranged from 0% to 4.8%, 0% to 10.0%, 0.4% to 3.9% and 1.7% to 24.1%, respectively. A positive linear correlation between recurrence rates and follow-up duration of the included studies was observed. Predictive factors included tumour to nipple distance less than 2 cm, disease stage, molecular subtype and lymphovascular invasion. Nipple-sparing mastectomy is oncologically safe with careful patient selection. Long-term follow-up of patients who undergo nipple-sparing mastectomy may be necessary due to the high rate of late recurrence observed in the included studies.

Long-Term Follow-Up of Patients with Axial Spondyloarthritis in Real-Life Setting: Results from Greece of the Multi-Country Registry Proof Study

Long-Term Follow-Up of Patients with Axial Spondyloarthritis in Real-Life Setting: Results from Greece of the Multi-Country Registry Proof Study

Impact of CT-angiography derived plaque characteristics on cardiac events in patients with a negative invasive fractional flow reserve.

Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for chronic coronary syndromes (CCS) improves outcomes compared with angiography-guided PCI, however cardiac events still occur during long-term follow-up of FFR-negative patients. In the PREVENT study preventive PCI reduced cardiac-events in lesions which were FFR-negative (FFR > 0.80) and had intracoronary imaging defined vulnerable plaque. Coronary computed tomography angiography (CTA)-defined high risk plaque (HRP) is known to predict future cardiac events. We hypothesized that CTA defined HRP would identify which FFR-negative patients were at greatest risk of future cardiac events. We examined 373 consecutive CCS patients undergoing CTA followed not more than 90 days later by invasive FFR. Cardiac events were defined as cardiac death, non-fatal acute coronary syndromes, and ischemia-driven revascularization. Clinical follow-up was performed in all patients at a median of 32 months. Revascularization was performed in 131 of the 373 patients due to an FFR ≤ 0.80 (Treat group), with the remaining 242 having revascularization deferred (Defer group) due to an FFR > 0.80. In the Treat group the cardiac event rates between patients with and without HRP on CTA were similar (9.4 % versus 10.1 %, p = 0.90), whilst in the Defer group they were higher in patients with HRP (21.1 % versus 4.7 %, Log-rank-p < 0.0001). In multivariate Cox hazard analysis the presence of HRP (Hazard-ratio 12.79, 95 %confidence-intervals: 3.57-45.83, p < 0.0001) was an independent predictor for cardiac events in the Defer group (UMIN000054067; CAPTURE). HRP on CTA was associated with future cardiac events in patients in whom revascularization was deferred due to a negative invasive-FFR.

Long-term recurrence after parathyroidectomy in primary hyperparathyroidism-do predictors exist?

Primary hyperparathyroidism (pHPT) is the third most common endocrine disease, affecting predominantly postmenopausal women. About 85% of cases are caused by a solitary parathyroid adenoma which leads to a hypersecretion of the parathyroid hormone (PTH) and consequently to elevated serum calcium concentrations. Parathyroidectomy is the only curative treatment. While a very low recurrence rate of 0.4-1.3% was previously thought, recent long-term studies have shown significantly higher recurrence rates at longer follow-up intervals of more than 6 months to several years, posing new challenges for surgeons. In addition, laboratory dynamics may occur in the early postoperative period that cannot yet be adequately explained in terms of long-term outcomes. Therefore, the aim of this study was to evaluate the long-term outcome after parathyroidectomy for pHPT at the Department of General Surgery at the University Medical Center Rostock with regard to late recurrences. This retrospective long-term follow-up evaluated the postoperative course after parathyroidectomy for pHPT. Based on 111 patients who underwent surgery at the Department of General Surgery at the University Medical Center Rostock between 2007 and 2017, 65 patients were followed for a median postoperative period of 41 months. In addition to normocalcemic PTH fluctuations in the early postoperative period, which is a well-known phenomenon, the result shows an elevated calcium or PTH concentration during a follow-up of more than 10 years. These results may predict late recurrence. Furthermore, it is not the preoperative PTH and calcium, but rather the preoperative serum creatinine that plays a role in late follow-up, contrary to expectations. The results emphasise the importance of long-term follow-up of patients who have undergone parathyroidectomy and may help to guide the development of institutional postoperative surveillance.

Long-term evolution of prepubertal-onset anogenital lichen sclerosus: A 35-year retrospective and cross-sectional study from a single tertiary care maternal and pediatric center

BackgroundAnogenital lichen sclerosus (ALS) in children may persist after puberty with potential clinical repercussions. ObjectiveThe purpose of this study was to evaluate post pubertal evolution of girls with ALS diagnosed in the prepubertal period based on physical examination, the persistence of functional symptoms and the effect on quality of life. MethodsWe retrospectively reviewed 65 cases of girls with prepubertal-onset ALS. Onset, signs/symptoms, photos, evolution and treatment were collected from the medical records. Subsequently, 30 of these 65 patients were assessed for persistence of signs/symptoms by physical examination and/or standardized questionnaire. ResultsSigns of active disease after puberty based on physical examination were present in 92% (N=23) of examined patients. A high proportion of cases with persistent ALS after puberty were asymptomatic (47%, N=14). LimitationsThis is a single center retrospective study with a limited number of patients. Half of our original cohort could not be reached or declined a follow-up visit. ConclusionPrepubertal lichen sclerosus is a chronic condition that can be asymptomatic after puberty despite continued disease activity. We recommend long-term follow-up of patients with prepubertal ALS to prevent associated morbidity.